Organization
ABBIEJEAN RUSSELL CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA ELVA GONZALEZ (OWNER)
(786) 385-4364
Entity
Organization
Contact information
Practice address
700 S 29TH ST, FORT PIERCE, FL 34947-3626
(772) 465-7560
(772) 465-5619
Mailing address
700 S 29TH ST, FORT PIERCE, FL 34947-3626
(772) 465-7560
(772) 465-5619
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF10020961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026875500
—
FL
01
—
M4K
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/11/2006
Last updated
07/31/2012
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